New vaginal ring could protect women from HIV

At the end of 2014, 36.9 million people were infected with HIV worldwide. In sub-Saharan Africa, women are more likely than men to be infected with the virus and make up 58% of people living with the disease there.

But the latest prevention effort, a silicone ring placed inside the vagina, might protect these women from contracting the infection. Firsthand accounts from those living in the region have highlighted an urgent need for discreet, long-acting, effective HIV prevention tools that women would actually want to use.

NIAID

The device, called a dapivirine ring, dispenses an anti-HIV drug into the vagina, and women are protected for a month. At the end of the month, they replace the ring with a new one. It's easy to insert and similar to a the vaginal ring some women use for contraception.

Yesterday, the National Institute of Allergy and Infectious Diseases (NIAID) in the US announced it would pay for more tests looking into the effectiveness of such a device after a study (called the ASPIRE trial) found that the ring provided a modest level of protection against the virus in sub-Saharan African women.

The ring reduced the risk of HIV infection by 27% in the study population overall and by 61% among women ages 25 years and older. But women under 25 didn't benefit from protection.

So scientists at NIAID want to find out why the ring worked reasonably well for older women, but was a failure in the younger group. The researchers need to determine if there's something biologically different about younger women, or if it was just behaviour. Were younger women removing the ring? After all, protection only works if you use it.

The new trial, called HOPE, will ask eligible women who took part in the first study to come back and try again. The participants will be told whether they received a ring with the active drug or placebo the first time round; and this time they'll all be given the real device. NIAID hopes the new study will give doctors a better idea of whether the ring can work. Dr Anthony Fauci, director of NIAID told NBC:

"If you could get a 61% efficacy in the older group, that means there is something about this that works. The real question is, in the real world, why is it not working in the younger group? If it had no efficacy in any age group, then you would say it was hopeless. It is very clear that this can work under certain circumstances."

NIAID currently funds a range of HIV prevention projects, from ring-based forms of protection with different drugs, to daily tablets, and even implants. The goal is to eventually provide women with a variety of effective ways to protect themselves against the virus.

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